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How to Treat Pain in a Lyme disease treatment image from Marty Ross MD

Pain is the result of inflammation and direct injury of certain tissues. In Lyme, white blood cells that attack germs produce inflammatory cytokines like interleukin-6 and tissue necrosis factor alpha. These cytokines have many effects that ultimately produce inflammatory prostaglandins and hypercoagulability (easy clotting) of the blood.

Hypercoagulability can lead to poor blood flow into tissues fed by small blood vessels because the blood becomes more "sticky". This can lead to poor oxygenation of all tissues including the muscles. When muscles do not receive sufficient oxygen they ache and can develop spasms. Common over-the-counter treatments for pain like ibuprofen and aspirin lower prostaglandins by blocking COX enzymes that are used to produce them. One way that cytokines increase pain is to increase the production of COX enzymes. Treatment approaches to reduce pain in Lyme work to lower inflammatory cytokines, decrease prostaglandins, improve blood flow to the tissues, and decrease muscle spasms.

Marty Ross MD Discusses Pain in Chronic Lyme Disease.

This is a Lyme Byte recorded during Conversations with Marty Ross MD on July 15, 2014.

Limit inflammatory cytokines. Based on the work of Martin Pall, PhD, anti-oxidants lower oxidizing agents that trigger cytokine production. Ecklonia cava extract derived from seaweed is a potent oral anti-oxidant which seems to have greater effect than other ones. Quercetin, an antioxidant bioflavonoid, is also an inflammatory kinase inhibitor. Kinases are enzymes required in the production of cytokines. Blocking kinases with quercetin interferes with the cytokine production line. Curcumin decreases inflammatory cytokine production too through a variety of intracellular mechanisms. Omega-3 fatty acids also decrease cytokine production.

Limit inflammatory prostaglandins. Curcumin and quercetin interfere with COX enzymes. Omega-3 fatty acids found in fish-oil also limit the production of prostaglandins through a variety of mechanisms. Note: curcumin found in food does not have these clinical effects because it is too poorly absorbed.

Improve tissue blood flow. Warm baths and infrared saunas are helpful because they lead to dilation of the small blood vessels which increases tissue oxygenation. Lumbrokinase, an enzyme from earthworms, can decrease the stickiness of the blood.

Decrease Muscle Spasm. Magnesium helps reduce muscle spasm. Of the various forms of magnesium, magnesium malate (malic acid) works best.

Neurological Pain

This is a unique type of pain due to nerve inflammation and injury. It has a variety of qualities including burning, stabbing, sharp, fire, and electric. Alpha lipoic acid, an antioxidant that is used to produce intracellular glutathione, repairs injured nerves and can help nerve pain. L-Theanine is an amino acid derivative that raises the neurotransmitter GABA. Increased GABA can decrease agitation, insomnia, and neurologic pain.

Recommendations

Basic approach

Take curcumin and omega-3 oil for pain. If this is not effective then add ecklonia cava with or without quercetin. When starting a treatment or when making a change, give 2-3 weeks to see the benefit.

  • Curcumin 500 mg 1-2 pills 3 times a day. Use a liposomal formulation that increases absorption and duration of the curcumin. Liposomal means the curcumin is microcopically wrapped in a layer of phospholipid fats.
  • Ecklonia cava 400 mg 2 pills 2 or 3 times a day.
  • Omega-3 fatty acids 500 mg 3 pills 1 time a day. Use a mercury free source.
  • Quercetin 250 mg 2 pills 3 times a day. The inclusion of chalone increases the absorption.

Muscle pain

Heat the body through warm baths or far infrared sauna. Start slow at about 10 to 15 min for each because the increase blood flow may trigger die off reactions. Build up to 30 min at a time daily if tolerated. Also use magnesium malate. If this is not effective then do a trial of lumbrokinase for 1-2 months. Be aware that this too could trigger a die-off reaction from increase blood flow and the removal of biofilms.

  • Magnesium malate 150 mg 1 pill 3 times a day. Take away from certain antibiotics including Biaxin and Zithromax.
  • Lumbrokinase 20 mg 1 pill 2 times a day on an empty stomach except water by 1 hour either side of taking it.

Neurological pain

Take this in addition to the basic approach. Start with L-theanine first only if there is insomnia and anxiousness or agitation too. You can take both of these together.

  • Alpha Lipoic Acid 350 mg 1 pill 2 times a day. May take a number of months to see the benefit.
  • L-Theanine 100 mg 1 to 3 pills 3 times a day (do not exceed 12 pills in 24 hour period). Adjust amount based on pain response and sleepiness.

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